HEPATITIS, OR THE LIVER COMPLAINT.
In India I have often had occasion to remark, that the acute hepatitis, of Cullen, was a disease of rare occurrence. The disease which comes before us most frequently, in India, is his chronic species; and in that, most frequently, there is neither pyrexia nor the “decubitus in latus sinistrum difficilis,” which, from having included in the definition of both of his species, I suppose the illustrious and accurate professor was induced to believe was a constant symptom in this disease. In very few of his definitions is there room for alteration; and I hope, for venturing here to suggest one, that I shall not incur the charge of presumption. But hepatitis was a disease, for accounts of which the accurate nosologist must have trusted to other sources than his own observation. It should be known, that very often we meet with this disease, when few of the symptoms of his definition are found. In India I have learned from some of the oldest practitioners, and from some gentlemen of abilities, the most respectable in the profession, that very commonly hepatitis is met with when all the symptoms of Cullen’s definition are wanting. In that country, when any of the abdominal viscera are complained of, we may in general suspect some error in the hepatic system.
In India, the liver seems to be the seat of disease in nearly the same proportion that the lungs are in England.
In Upper Egypt, and at Ghiza, we had many cases of hepatitis: it was the same disease that we had seen in India. At Rosetta and Alexandria a few cases did occur, accurately answering to Cullen’s definition of the acute species. Sergeant Levi, of the 88th regiment, was one instance. On the 13th of October, he was admitted into the hospital with this disease in a most violent degree. He had been ill only twenty-four hours: he had high inflammatory fever; his side was extremely tender to the touch; he had great irritability of stomach, and pain over the belly. He was twice bled: the anti-phlogistic regimen was for thirty-six hours applied in its utmost rigour: thereafter mercury was liberally thrown in, and he recovered. We remarked that many, who, in India, were the frequent subjects of repeated attacks of hepatitis, at length never complained, or they had the disease in the mildest shape, in Egypt. After the month of October, hepatitis was a disease of still more rare occurrence. In no corps did the number of cases bear any proportion to what they were wont to be in India.
During October a considerable number of cases occurred, but almost all of them were Europeans: the proportion of the natives who had this disease was always very small.
About the beginning of November several fresh cases occurred, and all of them were acute.
By the end of December this disease was fast disappearing in the army. In the last return of the month there were only twenty-one cases, and twenty of them were Europeans.
In January it still continued to decline. In the return of the 31st of this month there appear only nine cases, and all of them are Europeans.
In the first return of February there are only five cases, and all of them are Europeans.
There was an increase in March. In the first return of the month there were twelve cases, and all were Europeans.
In the last return of April the total number was so low as six, of which number four were Europeans.
At the time of embarkation, at Suez, there was not one case reported in the army.
Hepatitis appeared more in the Company’s artillery, and in the 10th regiment, than in any other corps of the army. For its predominance in the latter corps, one reason has been assigned, and which to me appears to have had the most powerful influence.
But on the whole, this disease, once so formidable to us in India, gradually ceased to appear in the returns of the sick.
The treatment of hepatitis it is unnecessary to dwell on: for no disease are we provided with a more effectual or sure remedy. If the season for applying the remedy be not lost, we are nearly, I think, as confident of a cure by mercury, and the analogous remedies, as we are in a case of syphilis by the same remedies.
To whom the world is indebted for the successful treatment of hepatitis by mercury, I cannot correctly say. The oldest written account of this practice, that I have seen, is in a very sensible pamphlet by Dr Paisley, formerly of Madras. There is another very distinct account of it in a pamphlet by Dr Girdlestone, of Yarmouth, formerly surgeon of a regiment in India.
For the general introduction of mercury, through the western side of the peninsula of India during the last twenty years, for the application of nitric acid to the same purpose, and for the discovery of some other preparations analogous to these, we are indebted chiefly to the ingenious Mr Scott, of Bombay. About ten years ago, from some experiments which he made on the calces of mercury, he discovered the analogy between them and nitric acid, and he was the first to apply this acid to the cure of hepatitis. Subsequently, he was led to the use of nitric acid and other analogous remedies in hepatitis and other diseases, which are curable only by mercury, a practice, of which, on a large scale for the last six years, I have observed the best effects, and which is now likely to get into general use in India.
I have said, that the species of hepatitis which we met with, at last, in Egypt, was not that usually seen in India, and a corresponding change was required in the treatment. Previously to giving mercury it was found necessary to premise the anti-phlogistic regimen.
In the use of mercury great address is often required; and, in substituting nitric acid and the analogous remedies, I am convinced, that much advantage may often be gained. Sometimes one of these remedies will succeed when the other has failed; and not unfrequently have I seen their combined use succeed where separately given they had failed. In obtaining a new agent we have acquired a great deal more power in the management of a disease, the most formidable to Europeans in the eastern world.
Sometimes in Egypt, and in many instances in India, I have observed, that I could not affect the gums with mercury, or with acid, till venæsection was performed. After this operation, I have often succeeded, and induced a flow of saliva, in cases which had long resisted a liberal use of mercury and nitric acid.
If the modern practice of giving but little mercury, and to make it only touch the gums, as it is called, without exciting a flow of saliva, be proper in the venereal disease, undoubtedly it is not in hepatitis. This disease never yields till the saliva flows freely—the explanation of this I do not attempt; but the fact is as I state it, and it is well known to every man who has practised extensively in India. Whenever the gums are hard, and insensible to the effects of mercury; when, instead of a salivation, they are red, painful, spongy, or blue, the prognosis is very unfavourable: in ninety of such cases out of the hundred we lose our patients.
In the first stage of this disease, I have derived benefit from cupping and blistering the side; but I never allow these remedies to interfere, or to delay the principal indications—the affecting the gums.
Dissection shews us the liver, of appearances considerably varied when this disease has existed some time. I have preserved notes of my dissections; they are not few. I made a rule of inspecting the body of every one that died under my care for several years past. At present, I shall only mention, in general, that sometimes the liver was of the natural consistence, sometimes harder, and that it was much varied in colour; but, generally, it was considerably increased in size. After the disease had lasted long, it was sometimes much wasted, and, in a few instances, of a very small size. In a majority of the fatal terminations, there were found vomicæ, or abscesses. When matter is formed, it is well known, that it makes its escape in various ways: here surgical aid may sometimes be of use.